›› 2013, Vol. 33 ›› Issue (2): 162-.doi: 10.3969/j.issn.1674-8115.2013.02.007

• Original article (Clinical research) • Previous Articles     Next Articles

Clinical study on treatment of IgA nephropathy with renal insufficiency by corticosteroid, corticosteroid combined with cyclophosphamide and corticosteroid combined with mycophenolate mofetil

WANG Wei-ming, JIA Xiao-yuan, PAN Xiao-xia, SHEN Ping-yan, LIU Jian, XU Li-li, LI Ya, WANG Zhao-hui, LI Xiao, REN Hong, ZHANG Wen, CHEN Nan   

  1. Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Online:2013-02-28 Published:2013-03-07
  • Supported by:

    Scientific Research Foundation of Medical Profession, 201002010；National Basic Research Program of China, 973 Program, 2012CB517700；Shanghai Science and Technology Committee Foundation, 08dz1900502

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Abstract:

Objective To investigate the clinical efficacy and safety of corticosteroid, corticosteroid combined with cyclophosphamide (CTX) and corticosteroid combined with mycophenolate mofetil (MMF) in IgA nephropathy (IgAN) with renal insufficiency. Methods Patients confirmed as primary IgAN by renal biopsy were selected, with chronic renal disease (CKD) of 3-4 stage and moderate renal lesions. Sixty patients were enrolled, and randomly received corticosteroid therapy (corticosteroid group, n=20), corticosteroid combined with CTX therapy (corticosteroid+CTX group, n=20) and corticosteroid combined with MMF therapy (corticosteroid+MMF group, n=20). The 24 h urine protein, renal function parameters and adverse effect were observed during treatment. Results With the time of treatment, 24 h urine protein was gradually reduced in each group, and 24 h urine protein in corticosteroid group and corticosteroid+CTX group 3, 6 and 12 months after treatment and in corticosteroid+MMF group 12 months after treatment was significantly lower than the baseline(P<0.05). The estimated glomerular filtration rates (eGFR) in corticosteroid+CTX group 6 months after treatment and in corticosteroid+MMF group 3 and 6 months after treatment were significantly higher than the baseline (P<0.05). There was no significant difference between serum creatinine 12 months after treatment and the baseline in each group (P>0.05). Eight patients (8/20) in corticosteroid+MMF group suffered from serious pulmonary infection during treatment for 3 to 4 months, the baseline eGFR of whom was significantly lower than that of patients without serious pulmonary infection in corticosteroid+MMF group (P<0.05). Conclusion Twenty-four hour urine protein can be significantly decreased with corticosteroid therapy, corticosteroid combined with CTX therapy and corticosteroid combined with MMF therapy in patients with IgAN and impaired renal function, and stable renal function can be maintained during treatment. Intensive follow-up should be carried out in the treatment with MMF due to the possibility of occurrence of serious pulmonary infection.

Key words: IgA nephropathy, chronic renal function failure, corticosteroid, cyclophosphamide, mycophenolate mofetil